eMedicine Specialties > Vascular Surgery > Medical Topics

Cholesterol Embolism: Treatment & Medication

Author: Lisa Kirkland, MD, FACP, CNSP, MSHA, Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital
Contributor Information and Disclosures

Updated: Nov 16, 2009

Treatment

Medical Care

Medical management is supportive.

  • Hemodynamic monitoring, including pulmonary artery catheterization, may be helpful for fluid and vasopressor adjustments.
  • If ARDS occurs, mechanical ventilation may be required for a prolonged period.
  • Dialysis should be started when indicated because patients can recover limited renal function.
  • Aggressive nutritional and metabolic support is essential because these patients often lose considerable lean body mass to ongoing catabolism.
  • Further invasive vascular procedures and anticoagulant or thrombolytic therapies should be avoided. If they are unavoidable, downstream protection devices to trap atheromatous debris after stenting or angioplasty are suggested.

Surgical Care

  • Surgical therapy, such as aortic aneurysm resection, may be necessary to remove the source of atheroembolic material. Stent-grafting may be less invasive method to reduce risk of embolization.
  • Damaged tissue should be protected and allowed to demarcate for several months. Surprisingly, a majority of the damage may recover. Necrotic tissue should be debrided, and establishing vascular access for dialysis also may be necessary.
  • In severe cases, lumbar sympathetic block (rarely, surgical sympathectomy) has been used to avoid impending lower extremity tissue loss resulting from intense vasoconstriction.

Consultations

  • Nephrologist
  • Critical care specialist
  • Metabolic and nutritional support specialists
  • General and/or vascular surgeons

Medication

Medical therapy is not particularly successful in patients with cholesterol embolism syndrome. Vasodilator therapy with calcium channel blockers may help relieve the local ischemia resulting from vasospasm, but angiotensin-converting enzyme (ACE) inhibitors should not be used because of their negative effects on renal afferent arterioles and the glomerular filtration rate. Patients presumed to have vasculitis have been treated with high-dose steroids and antiinflammatory agents, with anecdotal reports of recovery. However, steroids may predispose patients to infectious, metabolic, and nutritional complications and difficulties with wound healing. The use of anticoagulants is controversial because anticoagulants and thrombolytics have been shown to induce atheroemboli. Anecdotal reports of treatment with apheresis, iloprost, statin, colchicine, or combinations of these drugs with steroids report improvement in some cases.

More on Cholesterol Embolism

Overview: Cholesterol Embolism
Differential Diagnoses & Workup: Cholesterol Embolism
Treatment & Medication: Cholesterol Embolism
Follow-up: Cholesterol Embolism
Multimedia: Cholesterol Embolism
References
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References

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Further Reading

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Keywords

cholesterol, embolism, cholesterol embolism, cholesterol embolism syndrome, CES, atheroembolism, trash foot syndrome, hypertension, HT, distal ischemia, cholesterol crystals, cholesterol plaques, atherosclerotic plaque, atheroembolic events

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Contributor Information and Disclosures

Author

Lisa Kirkland, MD, FACP, CNSP, MSHA, Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital
Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard M Stillman, MD, FACS, Honorary Medical Staff, Northwest Medical Center; Former Chief of Staff and Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center
Richard M Stillman, MD, FACS is a member of the following medical societies: American College of Angiology, American College of Surgeons, Association for Academic Surgery, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Travis J Phifer, MD, Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport
Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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